Ptosis associated with monocular elevation deficiency

To document the various clinical features of ptosis associated with monocular elevation deficiency (MED) seen in patients, presenting to the Paediatric and Strabismus Unit, over a period of 2 years.

All patients seen with monocular elevation deficiency presenting to the Strabismus Clinic from January 2006 to December 2007 were examined and evaluated for presence of associated ptosis, jaw winking phenomenon and pseudoptosis. Patients having acquired causes of monocular limitation in elevation were excluded.

A total of 22 patients having MED were seen. Out of these 50% were males (N = 11) and 50% females (N = 11). Twelve (54.54%) had MED in the left eye and 10 (45.45%) had MED in the right eye. Ptosis was present in the eye affected with MED in 16 (72.72%) patients. Pseudoptosis was seen in 4 (18.18%) patients whereas no associated ptosis was noticed in 2 (9.09%) patients. Jaw winking phenomenon was present in 9 (40.90%) which comprise almost half (56%) the MED cases with ptosis.

Careful clinical assessment for ptosis, pseudoptosis and jaw winking phenomenon before forced duction test, can help in planning the correct order of surgical management of patients having monocular elevation deficiency. The patient needs to be counseled regarding the multiple surgeries required according to associated clinical features present with MED.